Provider Demographics
NPI:1720001209
Name:MAXWELL, MARVIN DWIGHT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:DWIGHT
Last Name:MAXWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 US HIGHWAY 27 N
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-1333
Mailing Address - Country:US
Mailing Address - Phone:863-314-0020
Mailing Address - Fax:863-314-0024
Practice Address - Street 1:4020 US HIGHWAY 27 N
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1333
Practice Address - Country:US
Practice Address - Phone:863-314-0020
Practice Address - Fax:863-314-0024
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCJ8463OtherRAILROAD MEDICARE PTAN
FL259459500Medicaid
FLF45680Medicare UPIN
FLCJ8463OtherRAILROAD MEDICARE PTAN